Healthcare Provider Details

I. General information

NPI: 1417907783
Provider Name (Legal Business Name): JOANNE I KASSIMIR OTR, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CONCORD STREET UNIT C
HAVRE DE GRACE MD
21078-4258
US

IV. Provider business mailing address

807A S UNION AVE
HAVRE DE GRACE MD
21078-3610
US

V. Phone/Fax

Practice location:
  • Phone: 516-662-6177
  • Fax:
Mailing address:
  • Phone: 410-939-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08884
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: